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Surgeon Q&A: “When Should The Mitral Valve Be Repaired?” asks Pamela

By Adam Pick on November 3, 2015

For our next ‘Ask Me Anything’ video from the Heart Valve Summit, we’re going to answer a great question from Pamela. In her Facebook post, Pamela asks, “When should the mitral valve be repaired?”

To answer Pamela’s question, I was very fortunate to connect with Dr. Marc Gillinov from the Cleveland Clinic. So you know, Dr. Gillinov is a valve guru having performed over 5,000 heart valve procedures during his career. Dr. Gillinov is also the co-author of Heart 411. And, Dr. Gillinov has successfully treated over 100 patients from our community! 🙂

Here are the highlights from my conversation with Dr. Gillinov:

Many thanks to Pamela for her question! And, a special thanks to Dr. Marc Gillinov for sharing his clinical experiences and research with our patient and caregiver community.

Keep on tickin!
Adam

P.S. For the hearing impaired members of our community, I have posted a written transcript of my video with Dr. Gillinov below.

Adam: Hi everybody, it’s Adam with heartvalvesurgery.com. We’re back at the Heart Valve Summit with Dr. Marc Gillinov from the Cleveland Clinic and we’re answering your questions that were submitted at our Facebook page. This question, Dr. Gillinov, comes in from Pamela Howard and she asks when do mitral valves need to be repaired?

Dr. Marc Gillinov: Pamela that is a great question. The answer is this: if you have a big leak – what we call severe regurgitation, get it fixed now. The rational for that is simple, early repair is best. Because the valve is broken, it’s not going to fix itself and eventually, it’s going to cause heart damage. Keep point here. If you have a valve that leaks a lot – severe mitral regurgitation – get it fixed soon. No benefit to waiting and some risk to wait.

Adam: Dr. Gillinov, as always, thanks for your great care of the patients in our community, and thanks for all your support of our community at heartvalvesurgery.com. Thank you.

Dr. Marc Gillinov: My pleasure.

Written by Adam Pick
- Patient & Website Founder

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Lyn says on November 4th, 2015 at 2:32 am

thanks Adam for sharing this, it was my question too.

Mo Battaglia says on November 4th, 2015 at 11:54 am

Hi Adam I am a 53 year old female with a mitral valve repair performed by David Adams at Mt Sinai in NYC in 2010. In Nov 2014, I was admitted to Tampa General Hospital with atrial fibrillation and pvcs (25%). A heart ablation was performed In December 2014 by Dr. Hedwig, which brought the pvcs down to around 5%, but resulted in 4 strokes shortly thereafter. I have a second ablation set for this December, however Dr Herwig is reluctant to proceed due to the previous strokes. The last three stress echo/TEEs show a narrowing of the valve and a foreign substance, either a suture or a clot for which I am being treated with Warfarin. I have two questions: 1) is developing pvcs (or skipped heart beats) normal after a valve repair? 2) other than surgery and the TEE, how else can the foreign substance on the valve be identified?

Eliza Hadjisotiriou Wilson says on December 18th, 2015 at 11:59 am

Hi, I am 54 yrs old and been diagnosed with moderate mitral valve regurgitation…I was told to do a follow up every six months…..but still I am extrmely worried….what advice can you give me

Frank Wendling says on January 22nd, 2016 at 12:24 am

I will be having mitral valve repair surgery by Dr. Gillinov in the very near future. I’ve read Dr. Gillinov’s impressive biographical sketch and am very glad I will apparently have him as my surgeon. But I do have some questions. The Cleveland clinic promotes mitral valve repair as the treatment of choice. From what I’ve read, most of Dr. Gillinov’s surgeries are either robotic surgery or minimally invasive surgeries. Apparently success rates are high and mortality rates are low for this type of procedure. However, it appeared to me that both robotic surgery or minimally invasive surgery are relatively new procedures. Data presented by the Cleveland Clinic go back to 2010. My question: Is five years sufficient to truly accurately establish success rates and mortality rates for a relatively new procedure?

Eliza Hadjisotiriou Wilson says on April 7th, 2016 at 11:00 am

Hope everything is alright by now

Eliza Hadjisotiriou Wilson says on April 7th, 2016 at 11:03 am

Many thanks Adam !! My question was answered with your video…with Dr Guillinov

Maria Gapinski says on January 11th, 2017 at 11:07 am

Hope you are doing well… It is best to wait until symptoms develop with severe regurgitation, working with your cardiologist. Very strong and healthy Asymptomatic Family member with severe MV regurgitation had non-invasive MV repair with excellent surgeon, and severe regurgitation returned after 9 months: so we are in watch and wait mode, with re-surgery on the horizon when symptoms begin.

Re-surgery is harder than the initial surgery, so it is best to wait until the cardiologist says it is time.

I did a lot of reading after the leak returned, and there are a lot of things that can “go wrong” and the leak returns: wrong sizing of the annuloplasty ring, wrong length of Gore-Tex chords, tying the last knot on the tissue instead of the clip (and the knot comes loose), having a too narrow coaptation line between the leaflets (the wider the coaptation line, the less likely it will leak later), onset of endocarditis, more valve degeneration, new leak starting in a new place after the first leak is fixed. Sometimes the leak returns after a successful repair and there is no apparent reason. One article said that MV repair durability is not constant, but varies per patient. Another article showed that the durability of MV repairs declines over time: http://circ.ahajournals.org/content/107/12/1609